Precise detection of the germinomatous component of intracranial germ cell tumors of the basal ganglia and thalamus using placental alkaline phosphatase in cerebrospinal fluid

J Neurooncol. 2021 Apr;152(2):405-413. doi: 10.1007/s11060-021-03715-9. Epub 2021 Feb 25.

Abstract

Purpose: The disadvantages of biopsy for lesions in the basal ganglia and thalamus include a risk of various complications, difficulty in selecting the target tissue in some cases due to indistinct neuroimaging findings and limited availability of sample tissue. Placental alkaline phosphatase (PLAP) plays a decisive role in the diagnosis and management of intracranial germ cell tumors (IGCTs) in the basal ganglia and thalamus. The present study aimed to demonstrate the ability, specificity, and optimal use of PLAP values obtained from cerebrospinal fluid (CSF).

Methods: Twenty patients with lesions in the basal ganglia and thalamus were enrolled in this study: 11 had IGCTs and 9 had non-IGCTs. The values of PLAP and other established tumor markers in the CSF were measured in all patients before treatment.

Results: The mean follow-up period was 76.0 months (range, 3-168) for all lesions. PLAP was elevated in all 11 patients with IGCTs in the basal ganglia or thalamus, whereas none of the patients with non-IGCT exhibited elevated PLAP. Thus, the sensitivity and specificity of PLAP were both 100%.

Conclusion: Our data demonstrated that the PLAP value can specifically identify the germinomatous component even in cases of IGCTs in the basal ganglia or thalamus with high sensitivity and specificity. PLAP is undoubtedly beneficial for the safe and timely detection of the germinomatous component of IGCTs in the basal ganglia and thalamus, because reliance on PLAP measurement enables us to avoid invasive surgical procedures and facilitates the prompt initiation of chemoradiation therapy.

Keywords: Basal ganglia; Biopsy; PLAP; Thalamus.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Alkaline Phosphatase / cerebrospinal fluid*
  • Basal Ganglia / pathology
  • Biomarkers, Tumor / cerebrospinal fluid*
  • Brain Neoplasms / cerebrospinal fluid
  • Brain Neoplasms / pathology*
  • Child
  • Female
  • GPI-Linked Proteins / cerebrospinal fluid
  • Humans
  • Isoenzymes / cerebrospinal fluid*
  • Male
  • Middle Aged
  • Neoplasms, Germ Cell and Embryonal / cerebrospinal fluid
  • Neoplasms, Germ Cell and Embryonal / pathology*
  • Sensitivity and Specificity
  • Thalamus / pathology
  • Young Adult

Substances

  • Biomarkers, Tumor
  • GPI-Linked Proteins
  • Isoenzymes
  • Alkaline Phosphatase
  • alkaline phosphatase, placental